Research Article

Vestibular function can be affected by autoimmune processes in rheumatoid arthritis

Abstract

Background and Aim: Autoimmune inner ear disease (AIED) may accompany certain systemic conditions, such as rheumatoid arth­ritis, and manifest audiovestibular dysfunction. This study aimed to compare the vestibular function between rheumatoid arthritis (RA) patients and normal subjects using cervical vestibular-evoked myogenic potentials and caloric tests.
Methods: In this cross-sectional study, 25 patients with RA and 20 normal subjects underwent pure tone audiometry, acoustic immittance, cervical vestibular-evoked myo­genic potentials (cVEMPs), and bithermal calo­ric test which eye movements were recorded by videonystagmography.
Results: Sensorineural hearing loss was found in 40% of patients with rheumatoid arthritis, which was significantly higher than controls (p<0.05). Biphasic waveforms of cVEMPs were obtained from all of the participants. There were no significant differences in mean peak-to-peak amplitude and asymmetry ratio between the two groups (p>0.05). The mean peak latency of p13 was significantly higher in RA patients (p<0.05). The mean peak latency of n23 was statistically different in the left ear (p<0.05), but in the right ear the difference was not significant (p>0.05). Unilateral weakness in patients with RA were significantly higher than those in the control group (p<0.05). The values of direc­tional preponderance were not significantly different between groups (p>0.05).
Conclusion: Audiovestibular dysfunction may present in the patients with rheumatoid arthritis to a varying degree. The possible pathology was discussed in here. Further studies may shade more light to the pathogenesis of the AIED.

1. Arend WP. The pathophysiology and treatment of rheumatoid arthritis. Arthritis Rheum. 1997;40(4):595-7.
2. Choy EH.S, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis, N Engl J Med. 2001;344(12):907-16.
3. Takatsu M, Higaki M, Kinoshita H, Mizushima Y, Koizuka I. Ear involvement in patients with rheumatoid arthritis. Otol Neurotol. 2005;26(4):755-61.
4. Gomides AP, do Rosário EJ, Borges HM, Gomides HH, de Pádua PM, Sampaio-Barros PD. Sensorineural dysacusis in patients with systemic lupus erythematosus. Lupus. 2007;16(12):987-90.
5. Ruckenstein MJ, Autoimmune inner ear disease. Curr Opin Otolaryngol Head Neck Surg. 2004;12(5):426-30.
6. Salvinelli F, Cancilleri F, Casale M, Luccarelli V, Di Peco V, D'Ascanio L, et al. Hearing thresholds in patients affected by rheumatoid arthritis. Clin Otolaryngol Allied Sci. 2004;29(1):75-9.
7. Salvinelli F, DAscanio L, Casale M. Staging rheumatoid arthritis: what about about otoacoustic emissions ? Acta Otolaryngol. 2004;124(7):874-5.
8. Yilmaz S, Erbek S, Erbek SS, Ozgirgin N, Yucel E.. Abnormal electronystagmography in rheumatoid arthritis. Auris Nasus Larynx. 2007;34(3):307-11.
9. Kakani RS1, Mehra YN, Deodhar SD, Mann SB, Mehta S .Audiovestibular functions in rheumatoid arthritis. J Otolaryngol. 1990;19(2):100-2.
10. King J, Young C, Highton J, Smith PF, Darlington CL. Vestibulo-ocular, optokinetic and postural function in humans with rheumatoid arthritis. Neurosci Lett. 2002;328(2):77-80.
11. Piras G, Brandolini C, Castellucci A, Modugno GC. Ocular vestibular evoked myogenic potentials in patients with acoustic neuroma. Eur Arch Otorhinolaryngol. 2013;270(2):497-504.
12. Sheykholeslami K, Murofushi T, Kermany MH, Kaga K. Bone-conducted evoked myogenic potentials from the sternocleidomastoid muscle. Acta Otolaryngol. 2000;120(6):73-4.
13. Fetter M, Aw S, Haslwanter T, Heimberger J, Dichgans J. Three-dimensional eye movement analysis during caloric stimulation used to test vertical semicircular canal function. Am J Otol. 1998;19(2):180-7.
14. Casse G, Sauvage JP, Adenis JP, Robert PY. Videonystagmography to assess blinking. Graefes Arch Clin Exp Ophthalmol. 2007;245(12):1789-96.
15. Colebatch J, Halmagyi G, Skuse GM, Myogenic NF. Potentials generated by a click-evoked vestibulocollic reflex. J NeurolNeurosurg Psychiatry. 1994;57:190-7.
16. Vanspauwen R, Wuyts FL, Van De Heyning PH. Validity of a new feedback method for the VEMP test Acta Otolaryngol. 2006;126(8):796-800.
17. Murofushi T, Shimizu K, Takegoshi H, Cheng PW. Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg. 2001;127(9):1069-72.
18. Barros AC, Caovilla HH. From nystagmus to the air and water caloric tests, Braz J Otorhinolaryngol. 2012;78(4):120-5.
19. Bhansali SA, Honrubia V. Current status of electronystagmography testing. Otolaryngol Head Neck Surg. 1999;120(3):419-26.
20. Zeigelboim BS, Jurkiewicz AL, Palmonari A, Alberti A, Filho AR, Ferrari KA. Otoneurological evaluation in women with systemic lupus erythematosus: a preliminary study. Intl Arch Otorhinolaryngol. 2006;10(2):126-31.
21. Özkırış M, Kapusuz Z, Günaydın İ, Kubilay U, Pırtı İ, Saydam L. Does rheumatoid arthritis have an effect on audiovestibular tests? Eur Arch Otorhinolaryngol. 2014;271(6):1383-7.
22. Farhadi R, Hajiabolhassan F, Akhlaghi M, Jalaie Sh, Akbarian M, Vestibular evoked myogenic potentials in patients with inactive stage of systemic lupus erythematosus, Audiol. 2013;22(2):63-72. Persian.
23. Bayir O, Comoglu SS, Ozdek A, Aytac E, Guven H, Ozdal MP, et al. Vestibular Evoked Myogenic Potential Responses in Behçet’s Disease. Int Adv Otol. 2012;8(1):113-7.
24. Erbek S, Erbek SS, Yilmaz S, Yucel E, Ozluoglu LN. Vestibular evoked myogenic potentials in Behcet's disease. Eur Arch Otorhinolaryngol. 2008;265(11):1315-20.
25. Rosengren SM, Colebatch JG. Ocular vestibular evoked myogenic potentials are abnormal in internuclear ophthalmoplegia. Clin Neurophysiol. 2011;122(6):1264-7.
26. Bruns A, Meyer O. Neuropsychiatric manifestations of systemic lupus erythematosus. .Joint Bone Spine. 2006;73(6):639-45.
27. Chin RL, Latov N. Central nervous system manifestations of rheumatologic diseases. Curr Opin Rheumatol. 2005;17(1):91-9.
28. Sheykholeslami K, Kaga K. The otolithic organ as a receptor of vestibular hearing revealed by vestibular-evoked myogenic potentials in patients with inner ear anomalies. Hear Res. 2002;165(1-2):62-7.
29. McCabe BF. “Autoimmune sensorineural hearing loss.” Ann Otol Rhinol Laryngol. 1979;88(5 Pt 1):585.
30. Stone JH, Francis HW “Immune-mediated inner ear disease.” Curr Opin Rheumatol. 2000;12(1):32-40.
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IssueVol 24 No 4 (2015) QRcode
SectionResearch Article(s)
Keywords
Rheumatoid arthritis cervical vestibular evoked myogenic potentials caloric test

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How to Cite
1.
Heydari N, Hajiabolhassan F, Fatahi J, Movaseghi S, Jalaie S. Vestibular function can be affected by autoimmune processes in rheumatoid arthritis. Aud Vestib Res. 2015;24(4):193-200.